Form 1 Block 4 - Created July 21

Question 1

presentation of hypoplastic left heart syndrome

Answer 1

when PDA closes around day of life 1: will see severe cyanosis, respiratory distress, and cardiogenic shock; need immediate tx of PGE1 to keep PDA open

Question 2

presentation of Staph aureus pneumonia

Answer 2

acute pulmonary sxs, rapidly progressive with acute decompensation, lower lobe infiltrate/cavitation; TB usually has upper lobe cavitation

Question 3

what to do if mother is Rh(D)(-) and has (+)anti-RhD Ab’s

Answer 3

check for anemia and hydrops; giving Rhogam is useless as the mom has already undergone alloimmunization

Question 4

presentation of pulmonary HTN

Answer 4

SOB, fatigue/weak, exertional angina, syncope, abd. distension/pain

Question 5

PE and imaging with pulmonary HTN

Answer 5

signs of right HF (JVD, LE edema), ascites, hepatomegaly, loud P2, TR; CXR shows enlarged pulm aa and nothing else

Question 6

standard prenatal lab panel

Answer 6

type and screen, CBC, U/A, UCx, tests for infections (rubella, varicella, syphilis, HIV, hep.B, chlamydia), pap test (?)

Question 7

confounding variable

Answer 7

correlates with both dependent and independent variables; can alter results if not controlled for

Question 8

effect modification

Answer 8

occurs when risk of a certain condition is present only within a certain subgroup of the population studied

Question 9

when to repair umbilical hernia in child

Answer 9

age 5

Question 10

underlying pathology in Gaucher disease

Answer 10

glucocerebrosidase deficiency

Question 11

clinical features of Gaucher’s disease

Answer 11

hepatosplenomegaly, anemia, low plt’s, bony pain, FTT, delayed puberty

Question 12

once PCOS dx made, what screening to do next?

Answer 12

oral GTT to check for DM; more accurate than HgbA1c

Question 13

joint aspiration cell counts to help narrow DDX

Answer 13

<2000: OA
2000-75k: RA and gout
>100k: infectious

Question 14

why early tx is important with shingles

Answer 14

reduces risk and severity of post-herpetic neuralgia and promotes healing of lesions

Question 15

presentation of disseminated gonococcus

Answer 15

fever/chills malaise with purulent monoarthritis OR with triad of tenosynovitis, dermatitis (isolated pustules), migratory polyarthralgia

Question 16

important fact about PEG tube placement

Answer 16

it does NOT improve outcomes in severely demented hospitalized patients

Question 17

what will prevent long-term disability in an RA pt?

Answer 17

cytotoxic meds (hydroxychloroquine, MTX, TNF-a inhibitors, rituximab)

Question 18

supportive features of potential Parkinson’s dx

Answer 18

bradykinesia, resting tremor, rigidity; asymmetric in presentation; improves with DA therapy

Question 19

2 causes of acute renal failure in pt after cardiac cath

Answer 19

1. aortic atheroembolism

2. contrast-induced nephropathy

Question 20

when to suspect aortic atheroembolism

Answer 20

atherosclerosis, skin changes in legs (livedo reticularis or blue toe), elevated serum and urine eosinophils; (note cholesterol is part of the embolus -> cholesterol crystal embolization)

Question 21

what to do in pt with hypovolemic hypoNa

Answer 21

give normal saline

Question 22

when hypertonic saline is appropriate

Answer 22

Na < 120 AND having seizures, obtunded, coma, or respiratory arrest

Question 23

mgt of acute pancreatitis

Answer 23

1. IVF, pain meds

2. start soft, low fat diet when pt’s appetite returns OR begin NG feeds at 72h

Question 24

mgt of gout pt starting meds for 1st time

Answer 24

allopurinol (to decr. uric acid production) + colchicine (as prophylaxis and a temp bridge); NSAIDs can be used in place of colchicine

Question 25

what med can dissolve large uric acid stones

Answer 25

potassium citrate

Question 26

what med can help increase urinary urate excretion

Answer 26

probenicid

Question 27

CHADS-VASc scoring

Answer 27

2 pts: age >74, prior stroke or TIA

1 pt: CHF, HTN, DM, vasc. dz, 65-74, Female

Question 28

effect on the heart with tension pneumothorax

Answer 28

air accumulates -> compressed vena cava -> decreased venous return -> hypotension

Question 29

need tx for human bite but PCN allergic

Answer 29

usually give amoxi/clav; instead, give clinda/cipro

Question 30

presentation of polycythemia vera

Answer 30

abnormal thrombotic event, splenomegaly, elevated Hgb, WBCs and plt’s

Question 31

how to verify dx of polycythemia vera

Answer 31

genetics (mutated JAK2)

Question 32

3 phases of postpartum thyroiditis

Answer 32

1. hyperthyroid for 1-3 mo.
2. hypothyroid for 4-6 mo.
3. euthyroid

Question 33

potential long-term complication of postpartum thyroiditis

Answer 33

usually transient, BUT, increased risk of persistent or recurrent hypothyroidism with a palpable goiter